“Midwives are the bridge”: Educator Duncan Shikuku on helping maternal health providers ease women’s fears and save lives

NAIROBI, Kenya – Midwifery educator Duncan Shikuku will never forget the day in 2011 when a new mother was rushed into the hospital where he worked, carried by her family.

“She was listless and bleeding. Within minutes, we had lost her,” Mr. Shikuku says. “No one should have to tell a family that their loved one has died, especially when it didn't need to happen.”

According to a new report from the United Nations, “Trends in maternal mortality”, nearly 800 maternal deaths occur each day – and almost all of these deaths are preventable. Although global maternal mortality has decreased by more than one third over the last two decades, hundreds of thousands of women and girls – mostly living in sub-Saharan Africa and Central and Southern Asia – continue to perish every year from avoidable complications like bleeding and infections, simply because long-known solutions are out of reach.

"It is unacceptable that so many women continue to die needlessly in pregnancy and childbirth,” said UNFPA Executive Director Dr. Natalia Kanem. “We can and must do better."

In Kenya, a large majority of births that took place in the country between 2018 and 2020 were overseen by skilled providers and occurred at health facilities. But these figures were higher for wealthier, more educated women in cities than for those with fewer resources and less education in rural areas. Meanwhile, one third of women reported completing fewer than the four or more antenatal care visits recommended by health experts to improve maternal health outcomes.

The woman who came to Mr. Shikuku’s hospital had given birth at home and only had one antenatal appointment. “I wish this was just one story – but it isn’t,” Mr. Shikuku said. “A community midwife could have saved her, but there just aren’t enough.”

Educate midwives; save lives

Midwives educated to international standards, who are licensed, regulated, fully integrated into health systems and working in interprofessional teams can help avoid about two thirds of all maternal and newborn deaths. But a global deficit, amounting to an estimated 900,000 missing providers, risks the lives of millions.

Addressing this shortage requires scaling up investment in midwives’ including in their education and training. It also requires confronting gender biases that can lead to poor pay and a lack of support for providers.

Mr. Shikuku, a nurse-midwife turned midwifery educator, says these issues have resulted in a dearth of midwives in Kenya. “Many aspiring medical professionals choose another career because midwifery is not recognised as a high-status job, and the sector desperately lacks investment,” he said.

To achieve his aim of ensuring no more women die in childbirth, Mr. Shikuku – supported by the Alliance to Improve Midwifery Education (AIME), of which UNFPA is a founding member  – helped design essential e-training targeting midwifery educators and maternity care providers  on topics related to the major causes of maternal mortality. More than 43,000 health care providers have already participated in the initiative, which launched in 2022.

"The new e-modules we designed are a game-changer,” Mr. Shikuku says. “They are training midwives and health professionals on issues like pre-eclampsia, offering life-saving information that can give every woman a safer, more positive experience during pregnancy.”

One million lives on the line

According to the new UN report, the world’s current rate of progress in reducing maternal deaths must accelerate or else risk the lives of one million women by 2030.

In Kenya, Mr. Shikuku is leading the charge not just to safeguard maternal lives, but also to ensure women are given respectful, compassionate care.

"Some women tell me that they fear the childbirth experience, but we can change that,” he says. “We can give women their right to proper health care at the most vulnerable and intimate time in their life.”

It is clear that for many, these efforts make all the difference; one mother even named her son after Mr. Shikuku, saying he had given her a beautiful birth experience.

"I still get messages from mothers 10 years after I delivered their babies – they never forget, and neither do I,” he said. “Midwives are the bridge between pregnancy and life in the outside world. What could be more important?

“I just wish everyone could see it too."